Detection and characterisation of colo rectal polyps

Abstract

Colonoscopy remains the gold standard for detection and resection of premalignant colo rectal polyps. The introduction reviews the literature on polyp detection and characterisation of colorectal polyps at colonoscopy. It describes how advanced technology could help to reduce polyp miss rates. The significance of small colo rectal polyps is reviewed and the developments of colonoscopic techniques to characterise polyps considered. First study examined the proportion of missed colorectal polyps at screening colonoscopies. It forms the platform for the subsequent studies to explore the ways the polyp detection could be improved. Three studies evaluated detection of polyps: Two studies, one of them was a pre-clinical study showed improvements in polyp detection with novel wide angle colonoscopes and a disposable distal attachment (Endocuff). Other study which assessed the role of careful inspection during insertion at screening flexible sigmoidoscopy, did not demonstrate any improvements in polyp detection. A cohort study described that how a novel efficiency marker could be utilised to compare the efficiency novel colonoscopy interventions. An image evaluation study explored the application of well validated classification of an electronic chromoendoscopy to other novel imaging modalities. Other two studies assessed the barriers in implementing optical diagnosis in routine clinical practice. A retrospective study assessed the prevalence of sessile serrated polyps in recto sigmoid colon in order to implement ‘detect and disregard’ policy for hyperplastic polyps in the region. Lastly, the learning curve of optical diagnosis in trainees was evaluated. It showed that the application of cumulative summation monitoring of the performance could be used to quality assure trainees performance of optical diagnosis.